Basic Information
| Provider Information | |||||||||
| NPI: | 1962797589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | HOLLIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 RESEARCH DR | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855394644 | ||||||||
| FaxNumber: | 7855398010 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 RESEARCH DR | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855394644 | ||||||||
| FaxNumber: | 7855398010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2011 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 53-75376-102 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 200748830A | 05 | KS | MEDICAID | 111354008 | 01 | MEDICARE | OTHER |